Treatment of Alcoholism with Psychedelic Therapy

Abram Hoffer

Introduction

Alcoholics Anonymous, the great self-help group-therapy
movement, is the only established treatment for alcoholics. Until
much more is known about the personal (biochemical and
psychological), familial, and social factors that contribute to
alcoholism, so it will remain. Most new therapies are merely
adjunctive to AA and will continue to be so until it is shown
that they have therapeutic value when used alone. In my view,
psychedelic therapy is best used as a preparation for AA.
When Bill W. and Dr. Bob founded AA, alcoholism had not been
accepted as a disease, either by society at large or by the
medical profession. Society considered it a moral problem, but
found itself confronted with an interesting dilemma, for only a
small proportion of the total drinking society drank excessively.
No moral sanctions were required for the majority, who eventually
made social drinking an integral part of the culture.
The majority who remained moral drinkers could not understand
why a minority became intemperate or alcoholic. Moral sanctions
were applied on the premise that excessive drinking arose from
defects of character, defects of will, and defects in society.
These sanctions included education, persuasion, incarceration,
and banishment. Unfortunately, the most stringent measures had
little permanent effect, and the proportion of the drinking
society (a concept developed by Dr. H. Osmond) remained the
same or increased. Medicine also considered alcoholism a
non-disease.
The founders of AA introduced the medical model first to
alcoholics, later to society, and finally to the medical
profession. This concept was very appealing to alcoholics because
it gave them a satisfactory explanation for their misfortunes. If
they were sick and not evil, then they might expect the same sort
of treatment they would receive if they developed pneumonia or
diabetes. Bill W. and Dr. Bob also introduced the concept of
allergy, which thirty-five years ago was incorporated into
medicine as a new group of diseases. (1) But AA insisted that alcoholism was more than a physical
illness. It also carried strong personal responsibility. An
alcoholic could not be censured for being an alcoholic, but he
could be for doing nothing about it.
Society resisted the idea that alcoholics are sick, since it
got no guidance from a reluctant medical profession. Doctors
expect diseases to be more or less definable, to have treatment
that may be ineffective but must be in common use, and to have a
predictable prognosis. When they became convinced that AA did
help large numbers of alcoholics remain sober, they gradually
accepted alcoholics as patients. Even now, the majority of
hospitals are extremely reluctant to admit alcoholics who are
drunk, and many doctors dread seeing them in their offices.
Eventually AA forced the profession to accept the fact that
alcoholism, which has been estimated to afflict 5 per cent of the
population, is a disease. This marked the beginning of the final
solution to the problem. For, having accepted the disease
concept, doctors were challenged by the enormous problems, and,
in a matter of a few years, several major therapeutic discoveries
were made.
The newer adjunctive therapies developed for alcoholism may be
divided into the psychological and the biochemical.
Psychotherapy, deconditioning therapy, and psychedelic therapy
are examples of purely psychological therapy, while sugar-free
diets for relative hypoglycemia, mega vitamin B3, megascorbic
acid, and adrenocortical extracts (or extracts of licorice) are
examples of pure chemotherapies.
Psychedelic therapy is the only therapy that has prepared
alcoholics to become responsible members of AA, when previously
they had been unable to do so.

Psychedelic Therapy

We must distinguish sharply between psychedelic reactions and
the means for inducing them. Failure to understand this
distinction has led to several futile researches, best
exemplified by the study of Smart and Storm (1964), which was
widely circulated in an extreme form before publication of the
watered-down version.
Psychedelic therapy refers to a form of psychotherapy in which
hallucinogenic drugs are used in a particular way to facilitate
the final goal, which for alcoholics is sobriety. The drugs may
be mescaline, LSD, psilocybin, and many others, as well as
combinations. It is therefore trivial to test the effect of LSD
or other hallucinogens on alcoholics in such a way that there is
no psychedelic reaction. In fact, these trivial experiences have
led to trivial data, as reported by Smart et al. (1966), who
claimed that a group of ten alcoholics given LSD did not differ
in outcome from a group of ten given another psychoactive drug.
Close examination of their report shows that no therapy was
given, nor was there any encouragement of discussion of problems.
The experience was not psychedelic, but was more in the nature of
an inquisition, with the subject strapped to the bed, pretreated
with dilantin, and ill from 800 mcg of LSD. Since no investigator
has ever claimed that LSD used in this way does have any
therapeutic effect, this experiment suggests that LSD used with
no therapeutic intent or skill is not apt to help. One of the
subjects given LSD by Smart et al. described his experience in
comparison with a psychedelic reaction he received from smaller
quantities of LSD in Saskatchewan. The experiences and the
outcome were quite different.
Psychedelic therapy aims to create a set and a setting that
will allow proper psychotherapy. The psychedelic therapist works
with material that the patient experiences and discusses, and
helps him resynthesize a new model of life or a new personal
philosophy. During the experience, the patient draws upon
information flooding in from the altered environment and from his
own past, and uses it to eliminate false ideas and false
memories. With the aid of the therapist, he evaluates himself
more objectively and becomes more acutely aware of his own
responsibility for his situation and, even more important, for
doing something about it. He also becomes aware of inner
strengths or qualities that help him in his long and difficult
struggle toward sobriety.
The book The Use of LSD in Psychotherapy and Alcoholism,
edited by H. A. Abramson (1967), contains the best collection of
scientific papers on psychedelic therapy.
Around 1952, Osmond and I had become familiar with
psychotomimetic reactions induced by LSD. There was a marked
similarity between these reactions and schizophrenia and the
toxic psychoses. Delirium tremens is one of the common toxic
states. It occurred to us that LSD might be used to produce
models of dt's. Many alcoholics ascribed the beginning of their
recovery to "hitting bottom," and often "hitting
bottom" meant having had a particularly memorable attack of
dt's. We thought that LSD could be used this way with no risk to
the patient. We treated our first two alcoholics at the
Saskatchewan Hospital, Weyburn, Saskatchewan, and one recovered.
Other early pilot studies were encouraging, and we increased
the tempo of our research until at one time six of our major
psychiatric centers in Saskatchewan were using it. As of now, we
must have treated close to one thousand alcoholics.
Within a few years after our first patients were treated, we
became aware that a large proportion of our alcoholics did not
have psychotomimetic reactions. Their experiences were exciting
and pleasant, and yielded insight into their drinking problems.
It became evident that a new phenomenon had been recognized in
psychiatry. Osmond created the word psychedelic to define these
experiences, and announced this at a meeting of the New York
Academy of Sciences in 1957.
Following this, our researches were aimed at improving the
quality and quantity of psychedelic reactions. Within the past
ten years, major studies, under the direction of Dr. Ross
MacLean, Hollywood Hospital, New Westminster, British Columbia,
and under the direction of Dr. S. Unger at Spring Grove State
Hospital, Baltimore, Maryland, have added materially to our
knowledge of the effect of psychedelic therapy on alcoholism.
I will not review the results of psychedelic therapy in
detail. This has been done in the books edited by H. A. Abramson
and in The Hallucinogens by A. Hoffer and H. Osmond
(1967). The one striking conclusion is that every scientist using
psychedelic therapy with alcoholics found the same proportion of
recoveries. Whether the experiments were considered controlled or
not, about 50 per cent were able to remain sober or to drink much
less. This seems to be a universal statistic for LSD therapy.

(1). Dr. Walter Alvarez recently told me that when he wrote a
paper on food allergies at the Mayo Clinic about fifty years ago,
he was severely criticized by his colleagues. Only strong support
from one of the Mayos, who discovered that he himself had a food
allergy, protected Alvarez from even-more-powerful assault.
Medicine seems very reluctant to take unto itself new diseases. (back)

Note: The rest of the paper discusses some technical
considerations of the psychedelic therapy method such as
contraindications, how to select subjects for psychedelic
therapy including various psychological and physiological
tests to be used, and a short summary of the method. PW